Help and advice

Genital herpes

Genital herpes is a common sexually transmitted infection (STI). It is caused by a virus called Herpes simplex. Most people who get genital herpes get it quite mildly but some will have painful symptoms.

Medication, education and self-help treatment help to reduce symptoms and limit the number of herpes outbreaks.

This page gives you information about genital herpes, what you can do if you are worried that you might have the infection and advice on how to protect yourself.

Genital herpes is caused by the virus Herpes simplex (HSV). There are two types, HSV-1 and HSV-2. Both types can infect the genital and anal area (genital herpes) and also the mouth and nose (cold sores) and fingers and hand (whitlows).

The virus enters the body through small cracks in the skin or through the moist soft lining (mucous membranes) of the mouth, vagina, rectum, urethra (tube where urine comes out) and under the foreskin. Following an infection by the Herpes simplex virus some people will experience an outbreak of genital herpes (see below, What are the signs and symptoms of the first outbreak of genital herpes?).

The virus then becomes dormant (inactive) and remains in the body where you were infected. In some people the virus can become active again from time to time and cause further outbreaks of genital herpes – known as recurrent outbreaks (see below, What are the signs and symptoms of recurrent genital herpes?).

In some people the body can shed the virus from the skin or mucous membranes without there being any signs or symptoms of genital herpes. This is called asymptomatic shedding or viral shedding. It is possible to pass the virus on during periods of asymptomatic shedding but for most people the risk is low. Shedding is higher in the first year after infection and if you have frequent outbreaks. The longer the time between outbreaks the less likely you are to have any asymptomatic shedding.

Many people will not have any visible signs or symptoms at all, or not be aware of them.

Some people will get symptoms within 4–5 days of coming into contact with the virus. In other people the virus may be in the body for several weeks, months or possibly years before any signs or symptoms appear. Therefore, when you get symptoms it doesn’t necessarily mean you’ve only just come into contact with the virus.

If you do get signs or symptoms, they usually follow a pattern. You may have some or all of the following:

Feeling generally unwell with flu-like symptoms such as fever, tiredness, headache, swollen glands, aches and pains in the lower back and down the legs or in the groin. This will be followed by:

Stinging, tingling or itching in the genital or anal area.

Small, fluid-filled blisters anywhere in the genital or anal area, on the buttocks and the tops of the thighs. These burst within a day or two leaving small, red sores which can be very painful.

Pain when passing urine (peeing) caused by the urine flowing over the sores.

In many cases, a doctor or nurse may diagnose genital herpes by looking at the affected skin. They will want to confirm this by taking a swab of fluid from the infected area, if they can. The swab will then be sent to the laboratory and the result will usually be known within 1–2 weeks.

A swab looks a bit like a cotton bud, but is smaller and rounded. It is wiped over the parts of the body that could be infected and easily picks up samples of fluid. This only takes a few seconds and may sting for a moment if the blisters and sores are tender.

There is a specific blood test that can be done to look for antibodies to the virus. This is not used as a routine test for genital herpes.

No tests are 100 per cent accurate. It is easier to diagnose genital herpes at the beginning of an outbreak when it is possible to take a sample of fluid from a blister or sore before it starts to heal. An accurate diagnosis will depend on the amount of virus that is being shed at the time, the stage of the blisters or sores and the type of test that is used on the swab specimen. The doctor or nurse will talk to you about how accurate your test result might be.

The aim of the treatment is to relieve the pain, and to prevent the virus from multiplying.

Treatment is recommended when you have the first outbreak as this may provide some relief.

Treatment is usually started within five days of the start of the first outbreak and while new blisters or sores are still forming. It involves taking antiviral tablets daily (sometimes up to five times a day) for five days. There are several different antiviral tablets that can be used.

Some people find it helpful to take antiviral treatment when they get another outbreak of genital herpes. You may be given some tablets to take at home. These need to be started as soon as the outbreak begins.

People who have repeated outbreaks (usually more than six in a year) may be given longer courses of the tablets to try to reduce the number of outbreaks. This is known as suppressive therapy. Suppressive therapy can stop outbreaks completely.

If you are pregnant, or trying to become pregnant, tell the doctor or nurse so they can talk to you about pregnancy and Herpes simplex. If you have an outbreak of herpes in pregnancy it is still possible to have treatment (see below, What happens if I have genital herpes when I’m pregnant?).

As genital herpes is caused by a virus and not bacteria, antibiotics will not help.

The treatment you can buy for facial cold sores is not suitable for genital herpes.

Outbreaks will last a different length of time in each person and will depend on your general state of health and whether this is the first or a recurrent outbreak of genital herpes. The first outbreak of herpes may last from 2–4 weeks in total.

The flu-like symptoms usually last for about a week.

Individual sores take around 5–10 days to heal. Once the sores start healing they are less painful.

Pain and irritation can last up two weeks or longer.

The signs and symptoms of a recurrent outbreak of genital herpes will usually last for a shorter time than the first outbreak.

Not necessarily. If the doctor or nurse would like to test for other sexually transmitted infections you may be asked to go back when the outbreak is over. This will be a good time to ask the doctor or nurse any other questions you may have.

It is not essential to have treatment as genital herpes will clear up by itself. However, prompt treatment at the start of an outbreak can be a great help – it can reduce the time the outbreak lasts, help the healing process and can reduce the risk of you passing the virus on to someone else.

It is strongly advised that you do not have any sexual intercourse, including vaginal, anal or oral sex, if you know an outbreak is coming, while you have signs and symptoms, and for a week after the symptoms have gone. This is to help prevent you passing the infection on to someone else.

Having sex while you have blisters or sores can also delay the healing process.

If you have had more than one sexual partner it can be difficult to know which partner you got genital herpes from. The genital herpes check-up cannot tell you how long the infection has been there. If you feel upset or angry about having genital herpes and find it difficult to talk to your partner(s) or friends, don’t be afraid to discuss how you feel with the staff at the clinic or general practice or with a support group.

If the check-up shows that you have genital herpes then it is not usually recommended that a partner has a check-up unless they have signs or symptoms. The doctor or nurse will talk to you about whether or not it may be helpful to tell your sexual partner(s) and how to do this. The Herpes Viruses Association has helpful advice on how you might talk to a sexual partner about herpes.

Most women who have genital herpes give birth to healthy babies. Genital herpes can be safely treated during pregnancy.

If you get genital herpes before you get pregnant the risk of passing it on to your baby at birth is very low and you do not usually need to have a caesarean delivery.

If you get genital herpes for the first time after you have become pregnant this may be more serious.

If the first outbreak of genital herpes occurs in the first three months of pregnancy, there is a small risk of miscarriage.

If you catch genital herpes for the first time late in your pregnancy you will not have time to pass on your immunity to your baby and the virus can be passed to the baby during vaginal delivery. In these cases a caesarean birth is often recommended.

Repeat outbreaks of genital herpes during pregnancy pose little risk to the baby at birth but you may be given some treatment to prevent an outbreak occurring when you are due to give birth.

You can get more information on genital herpes in pregnancy from www.rcog.org.uk.

The blisters and sores are highly infectious, so if you or a partner have cold sores or genital herpes:

avoid kissing when you, or a partner, have cold sores around the mouth

avoid oral sex when you, or a partner, have mouth or genital sores

avoid any genital or anal contact when you, or a partner, have genital sores or blisters, or if you feel an outbreak starting.

It is possible to get genital herpes and other sexually transmitted infections by having sex with someone who has the infection but has no symptoms. The following measures will help protect you from genital herpes and most other sexually transmitted infections including HIV, chlamydia and gonorrhoea. If you have a sexually transmitted infection they will also help prevent you from passing it on to a partner.

Use condoms (male or female) every time you have vaginal or anal sex.

If you have oral sex, use a condom to cover the penis, or a latex or polyurethane (soft plastic) square to cover the female genitals or male or female anus.

If you are a woman and rub your vulva against your female partner’s vulva one of you should cover the genitals with a latex or polyurethane square.

Avoid sharing sex toys. If you do share them, wash them or cover them with a new condom before anyone else uses them.

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This website can only give you general information about sexually transmitted infections. The information is based on evidence-based guidance produced by The British Association for Sexual Health and HIV (BASHH).

Remember – contact your doctor, practice nurse or a clinic if you are worried or unsure about anything.

INFORMATION LAST UPDATED JULY 2014. NEXT UPDATE DUE 2015.

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